Anthem Nurse Case Mgr I - Model of Care - PS9309 in Colorado Springs, Colorado

Nurse Case Mgr I - Model of Care - PS9309


Location: United States

Field: Medical

Requisition #: PS9309

Post Date: 6 days ago

Nurse Case Manager I

Preferred locations: CA, TX, OH, TN, KY, MO, CT,ME, NJ, NY

Open to US locations as well

Must live within 60 miles or 1 hour of localoffice

Hours: Any shift between 9:30 am - 6:30 pm

(depending on time zone)

Nurse Case Manager I - Modelof Care - Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically for discharge planning. Primary duties may include, but are not limited to:

  • Ensures member access toservices appropriate to their health needs.

  • Conducts assessments toidentify individual needs and a specific care management plan to addressobjectives and goals as identified during assessment.

  • Implements care plan byfacilitating authorizations/referrals as appropriate within benefitsstructure or through extra-contractual arrangements.

  • Coordinates internal andexternal resources to meet identified needs.

  • Monitors and evaluateseffectiveness of the care management plan and modifies as necessary.

  • Interfaces with MedicalDirectors and Physician Advisors on the development of care managementtreatment plans.

  • Negotiates rates ofreimbursement, as applicable.

  • Assists in problem solving withproviders, claims or service issues.

This position will allow you the flexibility to work from home anywhere within US, see above preferred locations.

You must reside within 60 miles to any Anthem office in the US, you must be available to go to office for training, technical computer issues, or if needed by needs of business. You must have a current unrestricted RN license.


  • BA/BS in a health related field;

  • 3 years of clinical RN experience;

  • Or any combination of education and experience, which would provide anequivalent background

  • Experience with electronic documentation

  • Knowledge and work experience with Microsoft Office (Excel andOutlook)

  • Current, unrestricted RN license

  • Experience using pc's with multiple screens

  • Multi-state licensure is required if this individual is providingservices in multiple states.


  • Certification as a Case Manager

  • Manage Care experience

  • Experience working with Medicare

  • Telephonic Case management experience.

  • Must be able to type at least 50 wpm from errors

  • Must be able to multi-task - talking and typing simultaneously

  • Critical thinking, self-paced learner, and operate technologyautonomously

  • Obtain MSL

  • Ability to go into office if needed

Anthem, Inc. is rankedas one of America’s Most Admired Companies among health insurers by Fortunemagazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. Tolearn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran